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The Nocebo Effect

robinson

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There is another thread about the Placebo effect, a well documented scientific phrase, used by researchers and Doctors everywhere. But the dark other side, is the Nocebo effect.

Some researchers believe that the nocebo effect is messing with people, especially concerning meds.

Placebo means "I will please" in Latin.
Nocebo means, "I will harm".

Dr. Arthur J. Barsky thinks it explains why some patients report side effects unrelated to the medication they are taking.

SOURCE/REFERENCE: The Journal of the American Medical Association 2002; 287:622-627

It really messes with drug trials because of the side effects. People getting a sugar pill have the same side effects as the real meds.

While much research is ongoing with the goal of using the placebo effect to enhance treatment of patients, the troubling Nocebo effect is also being studied. I wanted to bring it up in the same thread as Placebo, but the signal to noise ratio was a buzzkill.

Why would anyone think that the placebo/nocebo effects are Woo?

Discuss.
 
My wife was recently prescribed some new drugs. While the nurse was listing the possible side effects, she actually said “the standard headache, nausea, drowsiness”.

I couldn’t blame the nurse. She probably gets tired of repeating things that she knows probably had nothing to do with the actually drug. The real problem is that side effects that are a result of the drug get lost in the noise.
 
In every drug trial there is always a background rate of the usual, nausea, headache, and the rest of the common complaints I won't list for those who eat while reading.

But you have something else going on here besides people expecting and thus getting these side effects. You have someone asking them if they have them. As most of you know, people tend to find causality where there is mere association. So patients and research subjects don't recall all the headaches they had without the drug or placebo, instead, they conclude this headache is different and caused by the coincident event.

If you were to survey a group of people every day for a few months, you would find that we all experience minor symptoms of discomfort for which we either take no action or merely take some over the counter remedy and pay no more attention to it.

So Ohmer, the standard HA, N, and drowsiness is indeed just that, the standard. The way to determine if these effects are from the background rate or from the drug is by the comparison to controls. Unfortunately, it is the standard to list all those baseline symptoms in the drug insert because they were found in the studies. That makes it harder for the nurse and the patient to know when a side effect like headache really does occur with a drug unless they look in the drug insert for the percentage of patients experiencing the symptom, rather than just the symptom list.
 
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skeptigirl said:
...

...Unfortunately, it is the standard to list all those baseline symptoms in the drug insert because they were found in the studies. That makes it harder for the nurse and the patient to know when a side effect like headache really does occur with a drug unless they look in the drug insert for the percentage of patients experiencing the symptom, rather than just the symptom list.
Click to expand...
I did not know that. It really is unfortunate. I assume this means that a headache etc. is registered as a side effect in almost every single drug ever made. The only exception being drugs that don't really give headaches, that happened to be tested only on the very few people who never get headaches.

Couldn't they put a little asterisk next to the side effects that are significantly stronger than in the placebo group? Just to humor us skeptics... :p
 
Noone says the placebo effect is woo. We say this: is that Homeopathy is woo, and only works through the placebo effect. Bit of a difference there. ;)

Woops! Just noticed this was my 666th post!!!

:bubbles:
 
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My favorite was a drug given to treat nausea that had a “possible side effect” of nausea. I chuckled out loud. I think the nurses and pharmacists that we talked to did their best to give us useful information while still covering their asses. It’s one of those things I have come to expect in health care
 
Nausea, headache, drowsiness. Same triad of side effects from mobile phones, amalgam fillings, electricity pylons etc....
 
Ohmer said:
My favorite was a drug given to treat nausea that had a “possible side effect” of nausea. I chuckled out loud. I think the nurses and pharmacists that we talked to did their best to give us useful information while still covering their asses. It’s one of those things I have come to expect in health care
Click to expand...

My personal favorite was having to give intravenous drugs when the nurses refused to do it.

The one they most often refused to give was IV hydrocortisone.

In case it caused an allergic reaction.

The treatment for a severe allergic reaction is IV hydrocortisone.
 
I have personally observed extreme changes in people, based on their beliefs, or fears. The amount of chemicals some people can release from their own brains is awesome.

The behavior and energy level of someone on a Manic phase of Bi-Polar disorder is beyond anything you can fake. I don't think you could even give someone enough drugs to simulate an extreme manic period.
 
I'm sure we've all noticed the numerous commercials on t.v. for drugs where they have to list all the potential side effects. Have you noticed some of the creative ways Madison Ave has dealt with this?

My favorite "disclaimer" about side effects of ALL TIME has to be for Levitra.

"Erections lasting more than four hours, while uncommon, do require immediate medical attention."

WOW!!! Talk about turning lemons into lemonade!!!

As soon as that "disclaimer" hit the airwaves, I'm sure Levitra sales were through the roof! (And then there was the guy in the boardroom asking, "Erections lasting 8 hours are even more rare... But can will *still* disclaim those in the commercial?)

:D
 
How about the sleep-aid commercials that warn as a possible side effect, "may cause drowsiness." I should friggin' hope so!
 
StewartG said:
"Erections lasting more than four hours, while uncommon, do require immediate medical attention."
Click to expand...

Given the definitions in the OP, if one were to acheive a four hour errection after taking a sugar pill, would it be Placebo or Nocebo?

:eye-poppi
 
Ririon said:
I did not know that. It really is unfortunate. I assume this means that a headache etc. is registered as a side effect in almost every single drug ever made. The only exception being drugs that don't really give headaches, that happened to be tested only on the very few people who never get headaches.

Couldn't they put a little asterisk next to the side effects that are significantly stronger than in the placebo group? Just to humor us skeptics... :p
Click to expand...
Actually, the way the drug inserts are written, they usually distinguish between real risks by giving percent of people who had the effect and percent of controls who had them. The nurse may not have been ideally skilled or may not have had the time to read the insert more carefully, or it could have been out of his/her control and just been a discharge instruction form someone else wrote. I'd have to have been there to know.

Pdf file, see pg 19 for an example
 
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Dr Richard said:
My personal favorite was having to give intravenous drugs when the nurses refused to do it.

The one they most often refused to give was IV hydrocortisone.

In case it caused an allergic reaction.

The treatment for a severe allergic reaction is IV hydrocortisone.
Click to expand...
Why were the nurses afraid even if it could cause a reaction? Don't technicians push IV contrast media? That is a known risk for reaction and it doesn't stop technicians.

I recall giving IV hydrocortisone fairly routinely on a med-surg floor.

I'd say whoever was responsible for managing those nurses needed to do a little training. I would hope they could manage an allergic or other drug reaction that wasn't caused by an IVD.
 
robinson said:
I have personally observed extreme changes in people, based on their beliefs, or fears. The amount of chemicals some people can release from their own brains is awesome.

The behavior and energy level of someone on a Manic phase of Bi-Polar disorder is beyond anything you can fake. I don't think you could even give someone enough drugs to simulate an extreme manic period.
Click to expand...
I've seen addicts vomit before their fix. It's like Pavlov's dog.
 
StewartG said:
I'm sure we've all noticed the numerous commercials on t.v. for drugs where they have to list all the potential side effects. Have you noticed some of the creative ways Madison Ave has dealt with this?

My favorite "disclaimer" about side effects of ALL TIME has to be for Levitra.

"Erections lasting more than four hours, while uncommon, do require immediate medical attention."..
Click to expand...
I always chuckle at the 'immediate' part of that statement. No worry at 3 hours and 59 minutes but one minute more and you need help fast!
 
skeptigirl said:
Actually, the way the drug inserts are written, they usually distinguish between real risks by giving percent of people who had the effect and percent of controls who had them. The nurse may not have been ideally skilled or may not have had the time to read the insert more carefully, or it could have been out of his/her control and just been a discharge instruction form someone else wrote. I'd have to have been there to know.

Pdf file, see pg 19 for an example
Click to expand...

Our nurse really did do a good job. She was clear about what was important. Her “standard” comment correctly conveyed that we did not need to concern ourselves with some of the side effects listed because they are listed for just about everything. She interpreted the numbers for us like a good health care professional should.

I still find the existence of a “standard list” of side effects silly. I understand why it exists. It’s still silly.
 
StewartG said:
My favorite "disclaimer" about side effects of ALL TIME has to be for Levitra.
Click to expand...

I love the scene in a movie where the character calls the 800# on the package to report an 8-hour-plus erection.

After a few minutes of discussion, he confesses that he hasn't actually taken the product, but when he read the package's warning, he thought he should call just to be safe.
 
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